Exploring Sensory Processing Dysfunction,Parenting Stress,and Problem Behaviors in Children With Autism Spectrum Disorder

Abstract

OBJECTIVE. We examined problem behavior in preschool- and school-age children with autism spectrum disorder and assessed whether sensory processing dysfunction (SPD) and parenting stress were differentially associated with problem behaviors in these groups of children.

METHOD. Participants were 101 preschool- and 61 school-age children. An independent t test was used to examine group differences in problem behaviors. Pearson correlation analysis and multiple linear regression were conducted to identify associations among SPD, parenting stress, and problem behaviors.

RESULTS. Preschool children had more social withdrawal than school-age children. Moderately negative correlations were found between SPD and problem behaviors among preschool children. Parenting stress was a factor associated with problem behaviors in both groups, whereas SPD was a factor specific to preschoolers.

CONCLUSION. Understanding unique problem behaviors and the significant role of SPD and parenting stress in problem behaviors could help occupational therapy clinicians plan interventions accordingly.

Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by impairments in social communication and interaction as well as restricted and repetitive patterns of behavior, interests, or activities (American Psychiatric Association, 2013). In addition to the core symptoms, children with ASD also commonly have one or more internalizing or externalizing problem behaviors (Hartley et al., 2008; Totsika et al., 2011). Problem behaviors often exacerbate functional impairments in children with ASD, affecting their daily participation. Differences in physical and mental development between preschool and school-age children may underlie the differences in problem behavior patterns in these two age groups.

Few studies have compared problem behaviors in preschool and school-age children with ASD. Most relevant prior studies have examined problem behaviors at either preschool or school ages (Davis & Carter, 2008; Hartley et al., 2008; Ooi et al., 2011; Tseng et al., 2011). Only Lecavalier (2006) compared problem behaviors between preschool and school-age children with ASD. That study revealed that, relative to younger children, older children were more insecure and anxious and more commonly engaged in self-injury and stereotypical behaviors. However, Lecavalier’s findings have limited generalizability because the participants included children with diagnoses other than ASD, such as intellectual or developmental disabilities and language impairment.

In addition to problem behaviors, sensory processing dysfunction (SPD)—difficulty with detecting, integrating, and responding to sensory stimuli (Dunn, 1997)—has been frequently reported in children with ASD, with a prevalence of 69%–95% (Baranek et al., 2006; Tomchek & Dunn, 2007). Children with SPD are over- or underresponsive to sensory stimuli such that they display anxiety, withdrawal, aggression, or inattention when presented with certain stimuli (Lane et al., 2012). These behavioral characteristics parallel problem behaviors and hinder children’s interaction with others and participation in daily life (Lane et al., 2010). Empirical evidence also has demonstrated that SPD is associated with anxiety and social withdrawal in preschool children with ASD (Baker et al., 2008; O’Donnell et al., 2012) and correlated with attention problems and oppositional behavior in school-age children with ASD (Ashburner et al., 2008).

Previous studies examining the association between SPD and problem behaviors in children with ASD have involved small sample sizes (Ns = 22–42) and therefore had low statistical power (Ashburner et al., 2008; Baker et al., 2008; O’Donnell et al., 2012). Moreover, a meta-analysis conducted by Ben-Sasson et al. (2009) found that the extent of SPD in children with ASD differed by age group, and a similar trend was observed for problem behavior patterns (Lecavalier, 2006). To investigate the relationship between SPD and problem behaviors, children in different age groups should be examined separately. However, no research yet has compared preschool and school-age children with ASD with respect to the relationship between SPD and problem behaviors.

Previous research has reported that parenting stress was also an associated factor of problem behaviors in children with ASD (Bauminger et al., 2010; Davis & Carter, 2008; Hall & Graff, 2012). Parenting stress is the distress or discomfort resulting from the interaction between parents and their children (Abidin, 1995). Researchers have argued that parenting stress negatively influences parenting behaviors, such as harsh discipline, a lack of warmth, and less responsiveness when interacting with children, thereby increasing the risk of children’s problem behaviors, such as anxiety and aggressive behaviors (Davis & Carter, 2008; Deater-Deckard, 2004). The evidence is, however, inconsistent regarding the relationship between parenting stress and problem behaviors in children with ASD (Bauminger et al., 2010; Davis & Carter, 2008; Hall & Graff, 2012). Bauminger et al. (2010) found that parenting stress had a positive association with both internalizing and externalizing problem behaviors; however, other studies have reported that parenting stress had a positive relationship only with either internalizing (Hall & Graff, 2012) or externalizing problem behaviors (Davis & Carter, 2008). Furthermore, according to Barker et al.’s (2014) Chronic Parenting Stress Trajectory model, parenting stress may accumulate with children’s age; in other words, parents of older children tend to have higher stress than parents of younger children. The association between parenting stress and problem behaviors may differ in these two age groups; however, no published research has explored this possibility.

Understanding the role of SPD and parenting stress in problem behaviors could help occupational therapy professionals and caregivers provide appropriate intervention or accommodation to ameliorate problem behaviors in children with ASD. Thus, the purpose of the current study was twofold: (1) to determine whether preschool and school-age children with ASD exhibited different patterns of problem behavior, and (2) to explore whether SPD and parenting stress were differentially associated with problem behaviors in these groups of children.

Method

Research Design and Participants

We used a cross-sectional, correlational design to compare problem behavior patterns between preschool and school-age children with ASD and to explore SPD, parenting stress, and problem behaviors in these groups of children. A total of 162 children with ASD were recruited: 101 preschool children and 61 school-age children. The mean age of preschool children was 4.52 yr (standard deviation [SD] = 0.81), and that of the school-age children was 8.42 yr (SD = 1.33). Children were diagnosed by child psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000) and had a Catastrophic Illness Card with the diagnosis of autism issued by the Taiwan Bureau of National Health Insurance, Department of Health. The ethnicity of all participants in our study was Chinese.

Instruments

Child Behavior Checklist–Chinese Version.

Problem behaviors were measured using the Child Behavior Checklist–Chinese version (CBCL–C) for ages 1.5–5 yr or 6–18 yr (Achenbach & Rescorla, 2000; Chen et al., 2009). The current study included two broad-band syndrome scales, Internalizing and Externalizing Problem Behaviors, and five narrow-band syndrome scales that are common to both versions. The five syndrome scales were Anxious/Depressed, Somatic Complaints, Withdrawn, Aggressive Behavior, and Attention Problems. To compare the group differences, we transformed children’s raw scores into z scores using the means and standard deviations provided in the CBCL–C/1.5–5 and the CBCL–C/6–18. High scores reflect more problem behaviors. According to the CBCL–C manual, the clinical range indicates that “the person who completed the CBCL reported enough problems to be of clinical concern.” The assessment was reported to have good to excellent test–retest reliability (intraclass correlation = .66–.87; Leung et al., 2006).

Childhood Autism Rating Scale.

The Childhood Autism Rating Scale (CARS) was designed to distinguish children with ASD from children with other developmental problems (Schopler et al., 2002). It consists of 15 items rated on a 7-point scale ranging from 1 (normal) to 7 (severely abnormal). High scores reflect high symptom severity. The CARS has demonstrated moderately good internal consistency reliability (α = .94), interrater reliability (r = .71), and test–retest reliability (r = .88).

Short Sensory Profile–Chinese Version.

The Short Sensory Profile–Chinese version (SSP–C) is a 38-item parent questionnaire designed to measure SPD in children ages 3–10 yr (McIntosh et al., 1999; Tseng & Cheng, 2008). Items are rated on a scale that ranges from 1 (for behaviors that are always occurring) to 5 (for behaviors that never occur). Low raw scores reflect dysfunction of sensory processing. The SSP–C consists of seven subscales: Tactile Sensitivity, Taste/Smell, Movement Sensitivity, Underresponsive/Seeks Sensation, Auditory Filtering, Endurance, and Visual/Auditory Sensitivity. The internal consistency of the SSP ranges between .70 and .90, and the test–retest reliability of the SSP–C was .62‒.90 (Tseng & Cheng, 2008).

Parenting Stress Index–Chinese Short Form.

The Parenting Stress Index–Chinese Short Form (PSI–CSF) is a questionnaire designed to identify the stress in the parent–child system (Abidin, 1995; Wen, 2003). Parenting stress is measured with 36 items and divided into three subscales: Parental Distress, Parent–Child Dysfunctional Interaction, and Difficult Child. Items are rated on a scale that ranges from 1 (strong disagree) to 5 (strongly agree), with high scores reflecting high parenting stress. The Cronbach’s α of the three subtests and the total score ranged from .49 to .91 (Wen, 2003).

Procedure

Children with ASD from an ASD association, developmental centers, pediatric rehabilitation clinics, and rehabilitation departments of hospitals were invited to participate in this study. We distributed cover letters and consent forms to parents. Among 165 parents of preschool children who were given the information, 112 returned signed consent forms (67.87% response rate). Among 110 parents of school-age children, 69 returned signed consent forms (62.72% response rate). With informed consent, the child received assessment with the CARS, and parents received a package of questionnaires, including a demographic questionnaire, the SSP–C, the PSI–CSF, and the CBCL–C.

A total of 181 children’s questionnaires were returned. Among them, 19 were deemed invalid because of missing demographic data or incomplete questionnaires. For preschool and school-age children, 101 and 61 valid questionnaires were returned, respectively. This study was based on data collected from September 2010 to September 2015. Most of the questionnaires were completed by mothers (preschool group: 96.03%; school-aged group: 95.83%).

Statistical Analysis

All statistical analyses were conducted with IBM SPSS Statistics (Version 19.0; IBM Corp., Armonk, NY). Descriptive statistics were used to characterize the basic properties of the observed variables. An independent two-sample t test was used to compare the mean z scores of the problem behaviors. We used point-biserial correlations to examine the relationship between problem behaviors and categorical variables (e.g., gender and cognitive functioning level). The cognitive level was coded as a dichotomous variable according to formal cognitive assessments obtained from medical or school records. Children with an IQ of 70 or below were was assigned to the group considered to have impaired cognitive functioning, and children with an IQ above 70 were assigned to the group with no impairment.

Pearson correlation coefficients were used to examine the relationships between problem behaviors and all the continuous variables. Significance was set at α < .05, with Bonferroni correction for multiple comparisons and correlation analyses. Multiple linear regression models were applied to investigate associated factors of problem behaviors. The dependent variables were internalizing and externalizing problem behaviors. Gender, cognitive level, and total scores on the CARS, SSP–C, and PSI–CSF were examined as independent variables in regression analyses.

Results

Preschool children were aged 3.00 to 5.83 (n = 101), and school-age children were aged 7.00 to 10.92 (N = 61; Table 1). Bonferroni correction was applied (.05/8 comparisons, p < .006). No group difference was found in gender, χ² = 0.13, p = .717, or in symptom severity, t(160) = −1.99, p = .047. More school-age children (32.8%) than preschool children (5.9%) had impaired cognitive functioning, χ² = 20.343, p < .001. In addition, group differences were noted in the SSP–C subscale scores of Tactile Sensitivity, Movement Sensitivity, and Endurance, ts(160) = 3.00–4.65, ps < .006, as well as in the PSI–CSF subscale scores of Parent–Child Dysfunctional Interaction, t(160) = −3.50, p = .001 (see Supplemental Table 1, available online at http://otjournal.net; navigate to this article, and click on “Supplemental”).

Table 1.

Participant Characteristics of Preschool and School-Age Children With ASD

Characteristic	M (SD) or n (%)
Characteristic	Preschool Children (n = 101)	School-Age Children (n = 61)
Age, yr	4.52 (0.81)	8.42 (1.33)
Children’s gender
Male	85 (84.16)	50 (81.97)
Female	16 (15.84)	11 (18.03)
Cognitive level
Normal	95 (94.06)	41 (67.21)
Impaired	6 (5.94)	20 (32.79)
CARS total score	29.17 (6.71)	31.32 (6.51)
SSP–C total score	133.12 (21.19)	125.69 (16.77)
PSI–CSF total score	79.99 (15.01)	85.90 (17.90)
Parent participants
Mother	97 (96.04)	58 (95.08)
Father	4 (3.96)	3 (4.92)
Parents’ age	36.21 (4.04)	39.85 (4.78)

Note. ASD = autism spectrum disorder; CARS = Childhood Autism Rating Scale; M = mean; PSI–CSF = Parenting Stress Index–Chinese Short Form; SD = standard deviation; SSP–C = Short Sensory Profile–Chinese Version.

Table 2 displays data regarding internalizing and externalizing problem behaviors and five syndrome problems in preschool and school-age children with ASD. Bonferroni correction was applied (.05/7 comparisons, p < .007). No difference in z scores between the groups for Internalizing or Externalizing Problem Behaviors was noted. Despite the lack of significant differences, the means of Internalizing and Externalizing Problem Behaviors indicated that more Internalizing Problem Behaviors were noted in preschool children, whereas more Externalizing Problem Behaviors were observed in school-age children. For the five syndrome scales, a significant difference was noted in Withdrawn, t(160) = 4.60, p < .001, with preschool children having higher z scores compared with school-age children. No group differences were found in the other four syndrome problems (i.e., Anxious/Depressed, Somatic Complaints, Aggressive Behaviors, and Attention Problems). The percentage of children who scored in the clinical range of problem behaviors is listed in Supplemental Table 2 (available online).

Table 2.

Children’s Scores on the Internalizing Behaviors, Externalizing Behaviors, and Syndrome Scale Scores on the CBCL–C

CBCL–C Subscale	z score, M (SD)		t(160) a	p
CBCL–C Subscale	Preschool Children (n = 101)	School-Age Children (n = 61)	t(160) a	p
Anxious/Depressed	0.87 (1.47)	1.28 (1.59)	−1.69	.093
Somatic Complaints	0.43 (1.28)	0.82 (1.85)	−1.57	.117
Withdrawn	3.31 (1.74)	2.07 (1.52)	4.60	<.001*
Attention Problems	1.39 (1.02)	1.70 (1.05)	−1.82	.070
Aggressive Behaviors	0.71 (1.18)	1.08 (1.35)	−1.80	.073
Internalizing Problems	1.83 (1.58)	1.69 (1.54)	0.59	.556
Externalizing Problems	0.93 (1.12)	1.26 (1.32)	1.67	.096

Note. CBCL–C = Child Behavior Checklist–Chinese Version; M = mean; SD = standard deviation.

Independent two-sample tests.

p < .007.

Table 3 presents the correlations between problem behaviors and the independent variables. Bonferroni correction was applied for multiple comparisons for correlation analyses (.05/8 comparisons, p < .006). No significant correlation was noted between children’s gender and problem behaviors. Higher cognitive functioning level was correlated with more Externalizing Problem Behaviors in school-age children (r = .37, p = .003). Higher levels of autistic symptoms were correlated with higher Internalizing Problem Behaviors in preschool children (r = .30, p = .002). Significant negative relationships were found between total scores on the SSP–C and problem behaviors in preschool and school-age children (r = −.37 to −.68, ps < .006).

Table 3.

Correlations Among CBCL–C Measures of Problem Behaviors and the Associated Factors

Measure	Inter.	Exter.	An.	So.	Wi.	At.	Ag.
Preschool Children
Gender a	−.04	−.07	−.09	−.146	.11	−.01	−.08
Cognitive functioning level b	−.12	.04	−.02	−.04	−.26	−.07	.06
CARS (total score)	.30*	.15	.20	.09	.44*	.22*	.11
SSP–C (total score)	−.68*	−.62*	−.54*	−.55*	−.50*	−.48*	−.59*
PSI–CSF (total score)	.59*	.55*	.42*	.36*	.50*	.27	.56*
School-Age Children
Gender a	.04	.01	.09	.09	−.12	.12	.00
Cognitive functioning level b	.10	.37*	.21	.02	−.08	.30	.33
CARS total score	−.13	−.32	−.11	−.20	.07	−.15	−.29
SSP–C total score	−.39*	−.37*	−.28	−.26	−.37*	−.29	−.34
PSI–CSF total score	.45*	.61*	.39*	.16	.45*	.51*	.55*

Note. Ag. = Aggressive Behavior; An. = Anxious/Depressed; At. = Attention Problems; CARS = Childhood Autism Rating Scale; CBCL–C = Child Behavior Checklist–Chinese Version; Exter. = Externalizing Problem Behaviors; Inter. = Internalizing Problem Behaviors; PSI–CSF = Parenting Stress Index–Chinese Short Form; SSP–C = Short Sensory Profile–Chinese Version; So. = Somatic Complaints; Wi. = Withdrawn.

Point-biserial correlation coefficient of gender and cognitive functioning level.

Pearson correlation coefficient of continuous variables.

p < .006.

Significant positive relationships were found between the total score on the PSI–CSF and problem behaviors in preschool- and school-age children (rs =.36–.61, ps < .006; see Table 3). In addition, in preschool children the SSP–C subscale scores of Tactile Sensitivity, Taste Sensitivity, Smell Sensitivity, and Visual/Auditory Sensitivity were negatively correlated with four subscales in the CBCL–C, except for Attention Problems (rs = −.24 to −.54, ps < .006). In school-age children, only the SSP–C subscale score of Tactile Sensitivity was significantly related to the Withdrawn scale score (r = −.42, p = .001). The results showed that children with normal sensory processing functioning displayed fewer problem behaviors. All the PSI–CSF subscale scores were positively correlated with the Withdrawn scale score in preschool children (rs = .22–.50, ps < .006) and with the Attention Problems scale score in school-aged children (rs = .38–.52, ps < .006; see Supplemental Table 3, online). The results revealed that children whose parents had higher stress exhibited more problem behaviors. Moreover, moderately negative relationships were found between general sensory processing and general parenting stress in both preschool children (r = −.46, p < .001) and school-age children (r = −.42, p = .001), indicating that parents who had children with more severe SPD had higher parenting stress.

Table 4 presents the results of the stepwise linear regression, which takes into account the effect of covariates and further delineates the strength of these correlations. The linear regression model revealed that, for preschool children, Internalizing and Externalizing Problem Behaviors shared the same associated factors, that is, SPD and parenting stress. Gender, cognitive level, and severity of autistic symptoms were not entered as associated factors into the regression model in preschoolers. The results indicated that the higher the levels of general SPD and general parenting stress were, the more problem behaviors occurred. SPD and parenting stress accounted for 54.8% and 48.3% of the variance in Internalizing and Externalizing Problem Behaviors, respectively.

Table 4.

Multiple Linear Regression Analysis of Internalizing and Externalizing Problem Behaviors in Children With ASD

Significant Associated Factors	Estimate	Standardized Estimate	95% CI	p
Internalizing problem behaviors in preschool children (R ² = .55)
Sensory processing	−.39	−.52	[−.50, −.27]	<.001*
Parenting stress	.37	.35	[.21, .53]	<.001*
Externalizing problem behaviors in preschool children (R ² = .48)
Sensory processing	−.24	−.46	[−.33, −.16]	<.001*
Parenting stress	.28	.38	[.16, .41]	<.001*
Internalizing problem behaviors in school-aged children (R ² = .19)
Parenting stress	.39	.45	[.19, .59]	<.001*
Externalizing problem behaviors in school-aged children (R ² = .50)
Parenting stress	.48	.65	[.34, .61]	<.001*
Symptom severity	−.80	−.32	[−1.17, −.42]	<.001*

Note. ASD = autism spectrum disorder; CI = confidence interval.

p < .01.

In contrast, for school-age children, Internalizing and Externalizing Problem Behaviors shared only one associated factor: general parenting stress. In other words, the higher the parenting stress was, the more problem behaviors school-age children demonstrated. Moreover, the severity of ASD symptoms was another associated factor for Externalizing Problem Behaviors in school-age children. School-age children who had more autistic symptoms had fewer Externalizing Problem Behaviors. Gender, cognitive level, and SPD were not entered into the regression model as associated factors in school-age children. General parenting stress explained 18.8% of the variance in Internalizing Problem Behaviors. General parenting stress and symptom severity explained 50.1% of the variance in Externalizing Problem Behaviors.

Discussion

To the best of our knowledge, this is the first study to examine SPD and parenting stress as associated factors of problem behavior in preschool and school-age children with ASD. This study yielded two main findings. First, more social withdrawal problems were noted in preschoolers with ASD. Second, parenting stress was an associated factor of problem behaviors in both groups, whereas SPD was a particular factor for preschoolers.

Few studies have evaluated whether preschool and school-age children with ASD exhibit different problem behaviors. In this study, no difference was observed in broad-band problem behaviors (internalizing or externalizing problem behaviors) between these two age groups. However, with respect to narrow-band problem behaviors, preschool participants had more withdrawal problems than school-age participants. Previous studies have found that social withdrawal is more common in children with ASD than in typically developing children (Hartley et al., 2008; Tseng et al., 2011), and our results extend this finding by indicating that social withdrawal was particularly higher in preschool children with ASD. This may reflect the fact that, relative to school-age children, preschool children had less experience with school adjustment (Coplan et al., 2008).

As for the associated factors of problem behaviors, significant associations were found between SPD and both externalizing and internalizing problem behaviors in preschool children. This result supports previous studies reporting the association between tactile sensitivity and anxiety (Baker et al., 2008) as well as SPD and social withdrawal (O’Donnell et al., 2012). This correlation is probably the result of hyper- or hyporesponsivity to sensory input; children with SPD had difficulties regulating behavioral responses appropriately, resulting in increasing problem behaviors. Surprisingly, SPD was not an associated factor in the school-age group even though school-age children displayed more sensory behaviors in the SSP–C Tactile Sensitivity, Movement Sensitivity, and Endurance subscales than preschool children, a finding consistent with that of Ben-Sasson et al. (2009). It is possible that parents with older children were more experienced in handling children’s sensory behavior given that they had received a longer duration of intervention programs than parents with younger children.

General parenting stress was a crucial factor in both aspects of problem behaviors across age groups; that is, parenting stress was significantly associated with internalizing and externalizing problem behaviors in both preschool and school-age children. Our results support Bauminger et al.’s, (2010) study of school-age children and were similar to a prior finding that maternal parenting stress was correlated with internalizing problem behaviors in a group of toddlers with ASD (Davis & Carter, 2008). The relationship between parenting stress and problem behavior may be a bidirectional effect; that is, with increased problem behaviors in children, parents may exhibit higher stress, and higher parenting stress may lead to harsher discipline or less consistency in parenting behavior, which may in turn deteriorate the quality of parenting and further increase problem behaviors in children (Deater-Deckard, 2004). Alternatively, the pervasive and significant relationship between parenting stress and problem behavior may perhaps be attributable to Chinese parents’ emphasis on social norms. Children’s proper demeanor and decency become one of their major developmental goals and parents’ responsibility (Wang & Tamis-Lemonda, 2003), which incurs additional stress for parents.

Regarding symptom severity, it was associated with externalizing problem behaviors only in school-age children. In other words, children with higher symptom severity displayed fewer externalizing problem behaviors. This finding is in agreement with Matson et al.’s (2008) study, which demonstrated that children with more severe autistic symptoms engaged in less aggressive behavior. This may be because children with more severe ASD symptoms are more self-absorbed and appear to exist in their private world, thereby exhibiting fewer negative behaviors toward others (Farmer et al., 2015).

Among associated factors, we further found that parents who had children with more severe SPD had more general parenting stress. These results are consistent with previous findings that sensory features contributed to caregiver stress in parents of children with ASD (Kirby et al., 2015). This is probably because SPD may negatively affect a child’s daily functioning and family routine, leading to increased burden and stress in parents (Schaaf et al., 2011).

Limitations and Future Research

This study has several limitations. First, the cross-sectional design prevented us from examining how problem behaviors change with age. Second, these findings should be interpreted with caution because the participants were obtained by means of convenience sampling. Third, because of the difference in the number of subscales of the CBCL–C between the version for children ages 1.5–5 and the one for ages 6–18 (Achenbach & Rescorla, 2000; Chen et al., 2009), this study included only the subscales common to both versions. Finally, information about contextual factors, such as social support or school adjustment, was not included in this study. Future research adopting a longitudinal design is warranted to understand the development and trajectory of the associated factors and problem behaviors. In addition, future studies should take into account contextual factors for a comprehensive understanding of factors influencing problem behavior in children with ASD. Further studies using experimental designs are suggested to explore the causal relationship.

Implications for Occupational Therapy Practice

The results of this study demonstrate that preschool children with ASD had more social withdrawal than school-age children. They also indicate that parenting stress is a factor associated with problem behaviors in both groups, whereas SPD is a particular factor for preschoolers. This study has the following implications for occupational therapy practice:

Occupational therapy practitioners should recognize the need for assessing specific problem behaviors in children with ASD according to their age.

When managing problem behaviors in preschool children, clinicians may want to address SPD as well as parenting stress in addition to the core symptoms. For example, for an anxious child with auditory sensitivity, clinicians may want to apply strategies to dampen noise and decrease the child’s anxiety.

When managing problem behaviors in school-age children, clinicians may want to emphasize alleviating parenting stress by coaching parents in parenting skills and providing parent support groups.

Conclusion

This study identifies the different patterns of problem behaviors between younger and older children with ASD and is the first investigation to assess both SPD and parenting stress as associated factors of problem behaviors in children with ASD. Study findings showed that preschool children with ASD had more social withdrawal. Results also highlighted the significant role of parenting stress in problem behaviors in both groups, with SPD having a particular role in problem behaviors in preschool children only. Understanding the unique problem behaviors in specific age groups and the significant role of SPD and parenting stress in problem behaviors could help clinicians plan assessment and interventions accordingly.

Supplemental Material

Supplementary material for Exploring Sensory Processing Dysfunction, Parenting Stress, and Problem Behaviors in Children With Autism Spectrum Disorder

Supplementary material, sj-pdf-1-aot-10.5014_ajot.2019.027607.pdf for Exploring Sensory Processing Dysfunction, Parenting Stress, and Problem Behaviors in Children With Autism Spectrum Disorder by Wei-Chi Chiang, Mei-Hui Tseng, Chung-Pei Fu, I-Ching Chuang, Lu Lu and Jeng-Yi Shieh in The American Journal of Occupational Therapy

Footnotes

Acknowledgments

This study was supported by a grant awarded to Meh-Hui Tseng from the National Science Council of Taiwan (NSC 101-2410-H-002-125). We are grateful to the Autism Society Taiwan, the Department of Physical Medicine and Rehabilitation of the National Taiwan University Hospital, the DerMai Clinic, the Jiangtsun Clinic, and the Potential Development Center for Children With Autism for their assistance with recruiting participants. We sincerely thank Lu-Chi Hsiao, and I-Ting Wang for helping with data collection.

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